Background: in advanced head and neck tumors margins are very rarely comprehensively checked by frozen sections. the goal of this study was to analyze a new proposal for harvesting margins using a double- bladed scalpel. Methods: Thirty-eight patients underwent a comprehensive resection of advanced head and neck tumors with a double- bladed scalpel. Margins were mapped and checked by frozen sections, while tumor resection continued. When positive margins were identified, they were excised again, and checked by frozen sections. Results: Thirty-three patients (87%) had clear skin and soft tissue margins at frozen sections. Five patients (13%) had focal skin and soft tissue-positive margins at frozen sections, which were re-excised. Two patients (5%) had skin and soft tissue-positive margins only at permanent sections. One was reoperated and 1 received radiation therapy. the 3-year local control rate was 58%. Conclusions: in this preliminary study, the double- bladed scalpel appeared to be an interesting option for complete intraoperative evaluation of surgical margins of advanced head and neck tumors. Copyright (c) 2006 S. Karger AG, Basel.